Strength in Numbers: Opportunities for Enhancing the Development of Effective Treatments for Type 1 Diabetes-The TrialNet Experience

Diabetes. 2018 Jul;67(7):1216-1225. doi: 10.2337/db18-0065. Epub 2018 May 16.


The early to mid-1980s were an inflection point in the history of type 1 diabetes research. Two landmark events occurred: the initiation of immune-based interventions seeking to prevent type 1 diabetes and the presentation of an innovative model describing the disorder's natural history. Both formed the basis for hundreds of subsequent studies designed to achieve a dramatic therapeutic goal-a means to prevent and/or reverse type 1 diabetes. However, the need to screen large numbers of individuals and prospectively monitor them using immunologic and metabolic tests for extended periods of time suggested such efforts would require a large collaborative network. Hence, the National Institutes of Health formed the landmark Diabetes Prevention Trial-Type 1 (DPT-1) in the mid-1990s, an effort that led to Type 1 Diabetes TrialNet. TrialNet studies have helped identify novel biomarkers; delineate type 1 diabetes progression, resulting in identification of highly predictable stages defined by the accumulation of autoantibodies (stage 1), dysglycemia (stage 2), and disease meeting clinical criteria for diagnosis (stage 3); and oversee numerous clinical trials aimed at preventing disease progression. Such efforts pave the way for stage-specific intervention trials with improved hope that a means to effectively disrupt the disorder's development will be identified.

Publication types

  • Historical Article
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Biomarkers / analysis
  • Biomedical Research / methods
  • Biomedical Research / organization & administration*
  • Clinical Trials as Topic* / history
  • Clinical Trials as Topic* / methods
  • Diabetes Mellitus, Type 1 / diagnosis
  • Diabetes Mellitus, Type 1 / pathology
  • Diabetes Mellitus, Type 1 / therapy*
  • Disease Progression
  • Drug Discovery / history
  • Drug Discovery / trends
  • History, 20th Century
  • History, 21st Century
  • Humans
  • Patient Care Planning
  • Precision Medicine / methods
  • Precision Medicine / trends
  • Preventive Medicine / history
  • Preventive Medicine / methods
  • Preventive Medicine / trends
  • Remission Induction
  • Therapies, Investigational / methods
  • Therapies, Investigational / trends
  • Treatment Outcome


  • Biomarkers